Laparoscopic treatment of an incarcerated Littré’s femoral hernia

S.H. Sondji, C. Assoua, B. Majerus, J.P. Haxhe

Moderator(s): Henk Ten Cate Hoedemaker (Groningen, The Netherlands) & Harry van Goor (Nijmegen, The Netherlands)

12:40 - 12:50h at Jurriaanse Zaal

Categories: Session 7. Innovative techniques and future perspectives

Parallel session: Session 7. Innovative techniques and future perspectives

The protrusion of Meckel's diverticulum through a defect in the abdominal wall, known as Littré’s hernia is uncommon. This is usually inguinal, femoral or umbilical. Complications are even rarer. A few cases of incarcerated Littré's femoral hernia (ILFH) have been published. Clinical diagnosis is difficult. Ultrasound and tomodensitometry may help but correct diagnosis is often impossible before surgery. The treatment of an ILFH consists conventionally of resection of the Meckel's diverticulum and hernia repair with mesh by an open approach. Recently, a laparoscopic approach has been reported twice, that could provide certain benefits for diagnosis and treatment of ILFH. A hernia repair with mesh was performed in both cases. We present a case of ILFH treated through laparoscopic approach without mesh. A 72 years-old woman was admitted for a left inguinal swelling. The clinical examination revealed an irreducible and painful hernia. Ultrasound showed a left femoral hernia containing an incarcerated intestinal loop. Intervention was performed through laparoscopic transabdominal preperitoneal approach. Abdominal exploration showed an ILFH. The Meckel’s diverticulum was necrotic and perforated. It was reduced and excised by endostapling device. The femoral defect was closed by suturing the conjoined tendon down to the Cooper's ligament with non-absorbable stitches. We didn't use mesh because the risk of infection was high and the femoral ring defect was small. Postoperative course was uneventful and the patient was discharged on day 2. She didn't present any recurrence of hernia or residual pain. Incarcerated Littré's femoral hernia is a rare disease. The treatment is surgical and consists of a diverticulum resection and a hernia repair. Laparoscopic hernia repair without mesh may be a therapeutic option to treat ILFH when there is a high risk of infection. Herniorrhaphy is feasible and effective if the femoral ring is small.